Seaman J, Mercer A J, Sondorp H E, Herwaldt B L
Médecins sans Frontières-Holland, Amsterdam, The Netherlands.
Ann Intern Med. 1996 Apr 1;124(7):664-72. doi: 10.7326/0003-4819-124-7-199604010-00007.
Cohort study.
Médecins sans Frontières-Holland's treatment center in Duar, Western Upper Nile Province, an area in southern Sudan that has been severely affected by Sudan's civil war and a massive epidemic of visceral leishmaniasis.
3076 consecutive patients who had visceral leishmaniasis, were admitted to the treatment center the first year the center was operational (August 1990 to July 1991), and were treated with the pentavalent antimonial compound sodium stibogluconate.
Patient characteristics on admission and four mutually exclusive treatment outcomes (default during first admission, death during first admission, discharge and readmission for retreatment [relapse], and discharge and no readmission for retreatment [successful treatment]).
The patients had a median age of 15 years and were notably anemic (median hemoglobin level, 77g/L) and malnourished (median body mass index of adults [> or = 18 years of age], 15.2 kg/m2); most (91.0%) had been sick less than 5 months. Although patients could not be monitored after treatment to document cure, most (2562 [83.3%]) were successfully treated; 336 (10.9%) died during their first admission, and 79 are known to have relapsed (3.0% of those discharged alive [that is, those whose final treatment outcome was successful treatment or relapse]). In univariable analysis, young and older age (<5 or > or = 45 years of age), long duration of illness (> or = 5 months), markedly low hemoglobin level or body mass index, large spleen, high parasite density, and vomiting at least once during the treatment course were associated with death. In multiple logistic regression analysis of data for a subgroup of 1207 adults (those who did not default or relapse and for whom data were recorded on age, sex, duration of illness, hemoglobin level, body mass index, and spleen size), the approximate risk ratios for death were 2.2 (95% Cl, 1.4 to 3.6) for those with a long duration of illness, 3.6 (Cl, 2.1 to 5.9) for those 45 years of age or older, 4.6 (Cl, 2.2 to 9.4) for those with a hemoglobin level less than 60 g/L, and 12.2 (Cl, 3.2 to 47.2) for those with a body mass index less than 12.2 kg/m2. CONCLUSION; Despite the severe debility of the patients and the exceptionally difficult circumstances under which they were treated, most fared remarkably well.
1）确定在内战条件下且资源有限的情况下接受治疗的内脏利什曼病患者出现各种治疗结果的比例，以及2）确定与这些结果相关的患者特征。
队列研究。
荷兰无国界医生组织在西上尼罗省杜阿尔的治疗中心，该地区位于苏丹南部，受苏丹内战和大规模内脏利什曼病疫情严重影响。
3076例连续的内脏利什曼病患者，在该中心运营的第一年（1990年8月至1991年7月）入院，并接受五价锑化合物葡萄糖酸锑钠治疗。
入院时的患者特征以及四种相互排斥的治疗结果（首次入院期间违约、首次入院期间死亡、出院并再次入院接受再治疗[复发]、出院且未再次入院接受再治疗[成功治疗]）。
患者的中位年龄为15岁，明显贫血（中位血红蛋白水平为77g/L）且营养不良（成年[≥18岁]患者的中位体重指数为15.2kg/m²）；大多数（91.0%）患病时间少于5个月。尽管治疗后无法对患者进行监测以证明治愈情况，但大多数（2562例[83.3%]）得到了成功治疗；336例（10.9%）在首次入院期间死亡，已知79例复发（占存活出院患者的3.0%[即最终治疗结果为成功治疗或复发的患者]）。在单变量分析中，年龄较小和较大（<5岁或≥45岁）、病程较长（≥5个月）、血红蛋白水平或体重指数明显较低且脾脏肿大、寄生虫密度高以及治疗过程中至少呕吐一次与死亡相关。在对1207例成年人亚组（未违约或复发且记录了年龄、性别、病程、血红蛋白水平、体重指数和脾脏大小数据的患者）的数据进行多因素逻辑回归分析时，病程较长者死亡的近似风险比为2.2（95%CI，1.4至3.6），45岁及以上者为3.6（CI，2.1至5.9），血红蛋白水平低于60g/L者为4.6（CI，2.2至9.4），体重指数低于12.2kg/m²者为12.2（CI，3.2至47.2）。结论：尽管患者极度虚弱且治疗条件异常困难，但大多数患者情况良好。
